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Sperm Surface Antibodies: IUI vs. IVF Treatment
Objective: To compare the results of treating male immunological infertility using two different treatment options. Intrauterine Insemination (IUI) versus In-virto Fertilisation (IVF).
Design: Retrospective Study
Setting: IVF/Reproductive Endocrinology Unit, King AbdulAziz Medical City, Riyadh, Saudi Arabia.
Material and methods: Between year 1999 and 2005, 56 patients were recruited. Only patients with history of primary infertility and without any major cause of infertility such as tubal factor or anovulation were included. For all patients, the male partners had proven moderate to severe positive Mixed Antiglobin Reaction (MAR) test (IgG) (40-100%). Samples were collected by masturbation and examined according to the World Health Organization (WHO) criteria except for the morphology the strict Tygerberg criteria was followed. Samples were washed with Gradients or Swim-up. Couples were counselled for IVF; however, if they opted for IUI their choice was respected. The two treatment options were: IUI for a maximum of three cycles (Group I n=37 patients, who went for 56 cycles) or IVF (Group II, n=19 patients who went for 23 cycles).
Primary Outcome: Pregnancy rate.
Results: Mean BMI 30.68 ± 5.32 in (Group1) and 30.96 ± 5.65 in (Group II). Group I (IUI) 6 patients became pregnant giving a pregnancy rate (PR)/cycle of 11% and a PR/patient of 16.2%.Group II (IVF), 10 patients conceived giving a PR/cycle 43.5% and a PR/patient of 52.6% (P-value < 0.05).
Conclusion: Both the techniques of IUI and IVF revealed high pregnancy rates in the treatment of infertility due to sperm surface antibody. Ovarian hyperstimulation followed by IUI is much less invasive procedure for the patient than IVF. On the other hand, looking at the cost of HMG-IUI and IVF treatment cycle, we can support the super ovulation/IUI as the first option in the male immunological subfertility.
Afaf Felemban MD*, Seham M. Hassonah MD, Najla Felimban KD, Hadeel Alkhelb MD, Samar Hassan MD, Fahad Alsalman MD